Provider Demographics
NPI:1821364191
Name:COSTON, CHAYNE E (DDS)
Entity Type:Individual
Prefix:DR
First Name:CHAYNE
Middle Name:E
Last Name:COSTON
Suffix:
Gender:M
Credentials:DDS
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
Other - Suffix:
Other - Last Name Type:
Other - Credentials:
Mailing Address - Street 1:6029 SHAFFER DR
Mailing Address - Street 2:
Mailing Address - City:ALEXANDRIA
Mailing Address - State:VA
Mailing Address - Zip Code:22310-2275
Mailing Address - Country:US
Mailing Address - Phone:224-522-0339
Mailing Address - Fax:
Practice Address - Street 1:6029 SHAFFER DR APT 1412
Practice Address - Street 2:
Practice Address - City:ALEXANDRIA
Practice Address - State:VA
Practice Address - Zip Code:22310-2275
Practice Address - Country:US
Practice Address - Phone:224-522-0339
Practice Address - Fax:
Is Sole Proprietor?:No
Enumeration Date:2012-03-30
Last Update Date:2023-09-26
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
DC10017191223E0200X
VA040414186271223E0200X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223E0200XDental ProvidersDentistEndodontics